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Researchers have spent nearly two decades looking for chronic fatigue syndrome (CFS) causes and risk factors. Recently, a new suspect has come to the forefront — childhood trauma.

New research suggests that childhood trauma might be one risk factor that sets the stage for the development of chronic fatigue symptoms later in life. This is a controversial theory, however — some CFS advocates see it as an attempt to explain an ailment they consider a physical disease through psychology.

What Research Says About Childhood Trauma and CFS

Studies into the link between chronic fatigue syndrome and childhood trauma are based on the idea that events that occur at a young age can affect brain development.

“It is a well established fact that experiences during early life shape the development of the brain, particularly during sensitive periods,” says Christine M. Heim, PhD, associate professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta and a leading pioneer in this research. Traumatic experiences like infections, physical stress, and emotional strain can alter the development of portions of the brain that govern the body's hormonal, autonomic, and immune responses to such trauma. Later in life, the brain and body will react to trauma based on the fruits of this altered development.

Studies have found, for example, that people who experienced childhood trauma are more likely to experience stress and depression. Scientists believe the inflammation created by such trauma at a young age creates a tendency to experience such mood disorders. Reflecting this theory, inflammation caused by childhood trauma also might make someone more likely to develop chronic fatigue symptoms.

CFS occurs due to changes in the hormonal and immune systems similar to those caused by early trauma during brain development, including reduced cortisol levels and a heightened immune response, Heim says, explaining, “Both can contribute to symptoms of fatigue and pain. Therefore, we studied whether childhood trauma might be a risk factor for CFS.”

Among her study findings:

People with CFS reported significantly higher levels of childhood trauma than control subjects, most often emotional abuse, sexual abuse, and emotional neglect. In two studies, Heim found that exposure to childhood trauma was associated with a 3- to 8-fold increased risk of CFS, depending on the type of trauma.

Another study involving twins found that emotional instability and stress were associated with the later development of chronic fatigue symptoms, sometimes as long as 25 years later.

Heim says that just because there is a link doesn’t mean that childhood trauma alone causes chronic fatigue syndrome. “A risk factor is not ‘the cause’ of a disorder — it increases the relative risk, it is not present in all cases,” she says.

Heim's theory is that childhood trauma induces changes in the way the brain and body respond to traumatic experiences and challenging events. "The cause of CFS is still unknown, but likely is multi-factorial and [not uniform] across CFS patients, and childhood trauma might be a factor that contributes to CFS risk in a subset of cases,” she says.

Objections to the Trauma Theory

Research into childhood trauma and CFS is controversial, mainly because advocates have met extreme resistance over the years to having chronic fatigue syndrome taken seriously as a disease. They are concerned that some would use Heim’s findings to argue that the problem is “all in their heads.”

“There has been a strong media bias or cultural bias that something that has an unknown cause must be psychological,” says Patricia A. Fennell, MSW, president and CEO of Albany Health Management Associates Inc. in Latham, N.Y. “If we can't get a physical marker, if we can't get a blood marker, then it must be psychological, rather than that our science is not advanced enough to understand it.”

Fennell noted that researchers once attempted to explain multiple sclerosis and pediatric rheumatoid arthritis as psychological in nature, until science revealed both diseases’ true causes. “It helps to put CFS in the context of how any emerging disease is regarded and then how the chips fall 30, 40, or 50 years later,” she says.

Fennell further argues that the research is flawed because people with trauma histories are no more likely to develop CFS than any other illness or psychological disorder. “The alleged connection between CFS and childhood trauma is very shaky,” she says. “That research is very controversial, not only because of the premise, but how the methodology is arranged.”

As researchers continue to investigate chronic fatigue syndrome’s causes and risk factors, childhood trauma will be further assessed as a potential contributor to the disease. The truth of the matter remains a subject of intense debate.